按：痢疾开始兼表热者，柴、葛为最好的药品，往往表证一解，痢疾告愈者不胜枚举。而痢疾后期，阴虚有热之证或没有表证之痢疾则蛮升无益。又，银花生用重用非常有效，予根据寿甫之说用之已久，但炭剂并无尝试过，不知效果如何。芍药对湿热正盛之时可放胆用之，不必顾虑，这是毫无流弊的。
原文(四十二)：“痢久伤阳，脉虚滑脱者，治宜补气固脱。方用真人养脏汤。”
按：此证日久滑脱，大多数宜补气不宜补阳，因为此证阳虚寒证较少，热证较多，非真正有寒证，热性药不宜轻用。
原文(四十四)： “暑湿内袭，腹痛吐利，胸痞脉缓者，湿浊内阻太阴，宜缩脾饮。”
按：汪氏脉缓宜温之说不够确当，当从全面体会方能无误。
原文(四十五)：“暑月饮冷过多，寒湿内留，其证上吐下泻，水谷不分，肢冷脉伏，治宜温热之剂，调脾胃利气散寒，方用大顺散。”
按：仲景理中汤可作参考，但须注意确如其分，因为夏月寒湿之证，温补太过，往往转为痢疾。
原文(四十六)：“湿邪伤脾，寒邪伤肾，虚阳外越，其证腹痛下利，胸痞烦躁，口渴，脉数大按之豁然而空，治宜热因寒用，即热约冷服，方用冷香饮子。”
按：虚阳外越之旺必须根据孟英之辨证方法方能无误。《伤寒论·少阴篇》前二十九节解说评按
《伤寒论·少阴篇》从281节起至325节止，共45节，，在李翰卿遗留的资料里．有少阴篇前29节的临床解说按评／j为了忠实反映李老的治学方法和学术思想，特将这份不完整的资料如实整理抄录如下，而不作补充续写。
281．少阴之为病，脉微细，但欲寐也。
[解说]
少阴：是十二经中的心肾二经，即手少阴心经，足少阴肾经。仲景治疗伤寒按六经分病，只称少阴，不分手足，似乎双方并重，但临床上足经病证较多，所以古人有伤寒传足不传手之说。
少阴之为病：是说什么是少阴病。
脉微细：脉，是寸口桡骨动脉。微，是微小，由于气虚。细，是纤细，由于血虚。
但欲寐：是神识开始昏迷，有欲睡的状态。由于正气不 足，被邪所困。
[评按]
这是认识少阴病最主要的两种症状。古人所以叫作少阴的提纲。
282．少阴病，欲吐不吐，心烦，但欲寐，五六日白利而渴者，属少阴也．虚故引水自救。若小便色白者，少阴病形悉具。小便白者。以下焦虚有寒。不能制水，故令色白电。
[解说]
欲吐不吐：寒邪波及胃部的症状。
心烦：是心中麻烦，乃欲吐时的一种自觉症状。余乡称欲吐症状为心烦，正是这个意思。与热证心烦不同之处是没有口苦舌干、口渴喜饮、小便赤等症。
白利而渴：利是大便粪稀；自利是没有任何引起下利的外界因素而自然形成的下利证。这种下利由于肾阳虚而有寒，大肠中的水分不能完全吸收故下利。下焦的水分既不能充分吸收，上焦的津液因而不能敷市，故口渴。仲景引水自救之说，正是说明这种口渴不是热证。
小便色白：也是阳虚有寒主症之一。仲景之解释清楚，不必重复。
[评按]
本节的重点有二：第一，补充提纲中阳虚症状之不足；第二，提出类似热证之口渴证让人加以区别。
283．病人脉阴阳俱紧，反汗出者，亡阳也。此属少阴，法当咽痛而复吐利。
[解说]
脉阴阳俱紧：紧，是脉象如转索状。阴阳指尺寸而言。这是“寒邪直中少阴”主症之一，是沉脉中的阴阳俱紧，与太阳篇第3节浮脉中的阴阳俱紧完全不同。
反汗出：言不应当出汗而出汗，是阴寒太甚。阳虚不能卫外所致。
亡阳：是阳气虚到极点的名词。
此属少阴：是说明亡阳证为少阴经阳气将绝独有的证候，其他部分之阳虚有寒，都不可以亡阳称之。
咽痛：虚阳上浮所致。
吐利：阳虚外脱之故。
284．少阴病，咳而下利，谵语者，被火气劫故也。小便必难，以强责少阴汗也。
[解说]
咳而下利：是肾阳虚水气不化，上冲于肺则咳，下走于肠则利。
谵语：寒水证本不能骤发谵语，今忽有谵语者，是由于被火气劫，发汗，心神亢越之故，不是热证。
小便难：也不是热证而是津伤，故仲景自注云“以强责少阴汗也”。
[评按]
本节之谵语一证。是火乱神明或是心神亢越，从字面上是不易认识清楚的，必须在临床上细心体会方能确定。
285．少阴病，脉细沉数，病为在里，不可发汗。
[解说]
脉细沉数：细为血虚，沉为在里，数与沉细并见为血虚有热之里证。
病为在里不可发汗：凡有表证者，或表寒直中阴经者，或表里证相兼者，这样或多或少均有发汗之法；凡是里证，不论虚寒虚热，均无发汗之道理，所以说病为在里不可发汗。
[评按]
仲景52节云“脉浮而数者，可发汗，宜麻黄汤”。可见数脉并不忌汗，但数而浮，病在表者，方可汗之。若数而沉细，病在里者，绝没有发汗之必要。因为本节是从表里上着眼。而不是从寒热上着眼。
286．少阴病，脉微，不可发汗，亡阳故也。阳已虚，尺脉弱涩者，复不可下之。
[解说]
脉微：为阳气虚。
尺脉弱涩：为阴血少。
[评按]
真正的少阴病，在伤寒多是真阳虚，在温病便多是真阴虚．根本没有使用汗下的治法。麻黄附子二方是兼太阳之证。三承气汤证是阳极似阴的类似证，都不是纯粹的少阴证，决不可援以为例，以混淆少阴病的治法。
287．少阴病，脉紧，至七八日自下利，脉暴微，手足反温，脉紧反去者，为欲解也。虽烦，下利，必自愈。
[解说]
脉紧：是里寒证的脉象。
自下利：好像病势由寒转虚形成下焦虚脱之证。
脉暴微，紧反去：也好像是由寒转虚的脉象。
手足温，虽烦：只有这两种症状才是阳气回、阴寒退的主要现象。
[评按]
少阴虚寒之证能否治愈，主要以阳气之复与不复，阴寒之退与不退为标准。本节如果根据前三症来看根本没有自愈的希望，只有加上后二证才是阳回阴退的具体表现，才是病愈的真正标准。但“必自愈”三字，我认为不应该把它肯定起来，不用药等待自愈，仍应该根据症状作适当的处理，方不致误犯功败垂成之戒。
288．少阴病，下利，若利自止，恶寒而蜷卧，手足温者，可治。
[解说]
下利：是少阴病阳虚证。
利自止：有两种机制，一是阳气来复，一是阴尽阳绝。前者乎足温暖，后者手足厥冷。本节之利自止是属于前者，所以手足温。
恶寒而蜷卧：蜷卧是四肢蜷曲而卧，是恶寒较甚的表现。
[评按]
本节可治之机也是阳气较胜之故。
289．少阴病，恶寒而蜷，时自烦，欲去衣被者，可治。
[解说]
恶寒而蜷：是阳虚阴盛之证。
时自烦，欲去衣被：是阳气有来复之机。
[评按]
本病可治的关键也是阳气有来复之机的缘故。
290．少阴中风，脉阳微阴浮者，为欲愈。
[评按]
本节只言阳寸微，阴尺浮，并无其他症状，试问根据什么认为是少阴中风?病名尚不能肯定，又如何知道欲愈之脉?
编者按：上述评按是李老用红笔圈改后的字样。第一稿“病名”云云作“少阴中风有轻有重，难道任何中风这种脉象都是欲愈之脉?注家随文敷衍，有什么用处？”
291．少阴病欲解时，从子至寅上。
[评按]
六经欲愈的时间，只可作为服药时的有利条件，就是在这个时间前3小时把药服下去，可能增加一些治愈的希望。但真正的效果究竟还在药之对证与否，时间是不能肯定的。、
292．少阴病，吐利，手足不逆冷，反发热者，不死。脉不至者，灸少阴七壮。
[解说]
少阴病吐利：是阴盛阳虚的寒证。
f足不逆冷，反发热者：是阳回阴退之热证，所以这两种症状并见绝不是死证。
脉不至：是吐泻交作之时，正气暴虚，脉象一时不能接续(急性霍乱证者经常发现)。
灸少阴七壮：即少阴经之太溪穴，在内踝后跟骨动脉陷中，七壮即艾炷七个以通阳复脉。
[评按]
本证内服温药外用灸法并行不悖，很有好处。陶氏用好酒姜汁半盏内服法也可试用。
293. 少阴病，八九日，一身手足尽热者，以热在膀胱，必便血也。
[解说]
少阴病：此病应当脉微细数。
一身手足尽热：是少阴心经血虚有热。
热在膀胱：足心热由小肠而及于膀胱也。
便血：指小便血，这也是热伤阴络之证。
[评按]
过去书多多有寒邪变热之说，根据实践，除伤寒阳明汙一方面由于患者素有内热，一方面由于伤了津液，这样是可能寒化为热的，至于少阴寒证主要由于阳虚所致，纵有发热之证，不是阴盛于内，格阳于外，或阴盛于下，格阳于上的假热，便是开始时期的太阳兼证，而真正阴寒变为阳热之证，从来没遇过。可能我的经验不多，也未可知，希望全国前辈多多指教为盼。
至于治疗之法，柯氏所用之黄连阿胶汤最宜，但苦燥之药应当少用，因为此证多属于阴虚之热，如果是真正实热，绝不可以少阴名之。
294．少阴病，但厥无汗，而强发之，必动其血，未知从何道出，或从口鼻，或从目出者，是名下厥上竭，为难治。
[解说]
但厥无汗：少阴病阳气衰微，不能温煦四肢，故手足厥冷，更不能蒸发津液而为汗，故无汗。这是少阴病的正常现象。
而强发之：少阴病除兼太阳发热证可以温阳微汗外，决不可强用发汗之法治之。
必动其血：如果强发其汗必然会形成各部出血证，因为汗为血之液，发汗药多辛温之品，所以不得其汗必动其血。
下厥上竭：下厥是指阳亡于下的厥证而言，上竭是指阴竭于上的出血而言。
难治：下厥当用热药，上竭当用凉药，相反相妨故为难治。
[评按]
各病的治法都必须根据古人多年来的经验，有成方者必须结合具体症状选用成方，有成法者也必须结合具体症状选用成法，既无成方又无成法者也可以触类引申以研究新的治法，这样即便不见效也绝无害处。如果无原则地随便用药，鲜有不损人者。本节强发汗之法，正是随便乱用药的典型事例，学者应当引以为戒。
295．少阴病，恶寒身蜷而利，手足厥冷者，不治。
[解说]
恶寒：阳气不足之证。
身蜷而利：阳虚寒甚之证。
手足逆冷：真阳已败之证。
不治：是因纯阴无阳之故。
[评按]
舒驰远说：此证尚未汗出息高，急投四逆加人参或可不死。我认为年龄体质及发现阴寒证的时间都有关系，在用药上宁重勿轻，并宜频频服之，使脉象逐渐恢复，以防止脉暴出的危险。
296．少阴病，吐利躁烦，四逆者死。
[解说]
吐利：是肠胃寒盛之证。
躁烦：躁系手足躁扰不安，为阳气欲离，属肾；烦系心中烦乱不耐嘈杂，为阳气无依。余详本证。
四逆：是手冷过肘，足冷过膝，乃阳亡之证。
[评按]
此系阳虚欲脱之候，故属死证，但在未死之前仍宜设法挽救，不可坐以待毙。要尽医者之责任，但必须预先告知病者亲属，以免误会。
297．少阴病，下利止而头眩，时时自冒者死。
[解说]
下利止：是阴竭于下，不是阳气有回复之机。
头眩：阴竭于下，阳无所附，浮越于上，故头眩。
时时自冒：冒是神识昏冒，由于阳浮于上，神气散乱之故。
[评按]
本节之死，是由于阴竭于下，阳脱于上之故。
298．少阴病，四逆恶寒而身蜷，脉不至，不烦而躁者死。
[解说]
四逆：手冷过肘、足冷过膝的阴盛阳亡之证。
恶寒身蜷：是怕冷得厉害，身体蜷缩为一团。
脉不至：由于阴寒过盛，血脉不能畅行四肢，所谓真阳败绝之证。
不烦而躁：阳盛则烦，阴盛则躁，不烦而躁者，有阴无阳也。
[评按]
本节之死是有阴无阳之故。
299．少阴病，六七日，息高者死。
[解说]
息高：是仅能呼气而不吸气之证，乃肾气下绝，肺气上脱之故．
[评按]
本节致死之由是肾中生气已绝的缘故。
300．少阴病。脉微细沉，但欲卧，汗出不烦，自欲吐，至五六日自利，复烦躁不得卧寐者死。
[解说]
脉微细沉：是少阴病之本脉。
但欲卧：是少阴病之本证。但较寐证轻。
汗出不烦：汗出是阳气外亡，不烦是内无热象。
自欲吐：是阴寒上逆。
至五六日自利：日期迁延较多，病势有所发展，故由吐而利。
复烦躁：是加上心中烦乱、手足躁扰不安之证。
不得卧寐：是因烦躁而发展为不能卧、不能睡之证。
[评按]
按语：痢疾初期兼有表热的，柴胡、葛根是最好的药物，往往表证一解，痢疾就好了，这样的例子不胜枚举。而痢疾后期，阴虚有热的证候或没有表证的痢疾，则盲目升提毫无益处。另外，银花（金银花）生用且重用非常有效，我根据张寿甫的说法使用它已经很久了，但炭剂并没有尝试过，不知道效果如何。芍药在湿热正盛的时候可以放心大胆地使用，不必顾虑，这是没有任何弊端的。
原文（四十二）：“痢疾日久损伤阳气，脉象虚滑且有脱肛症状的，治疗应当补气固脱。方剂用真人养脏汤。”
按语：此证日久滑脱，大多数适宜补气而不宜补阳，因为此证阳虚寒证较少，热证较多，并非真正的寒证，热性药物不宜轻易使用。
原文（四十四）：“暑湿内袭，腹痛吐利，胸痞脉缓的，是湿浊内阻太阴，适宜用缩脾饮。”
按语：汪氏认为脉缓宜温的说法不够确切，应当从全面体会才能无误。
原文（四十五）：“暑月饮水过多，寒湿内留，其证上吐下泻，水谷不分，肢冷脉伏，治疗适宜温热之剂，调理脾胃利气散寒，方剂用大顺散。”
按语：仲景的理中汤可作参考，但必须注意确如其分，因为夏月寒湿之证，温补太过，往往转为痢疾。
原文（四十六）：“湿邪伤脾，寒邪伤肾，虚阳外越，其证腹痛下利，胸痞烦躁，口渴，脉数大按之豁然而空，治疗适宜热因寒用，即热药冷服，方剂用冷香饮子。”
按语：虚阳外越的旺势必须根据孟英的辨证方法才能无误。《伤寒论·少阴篇》前二十九节解说评按
《伤寒论·少阴篇》从281节起至325节止，共45节，在李翰卿遗留的资料里，有少阴篇前29节的临床解说按评。为了忠实反映李老的治学方法和学术思想，特将这份不完整的资料如实整理抄录如下，而不作补充续写。
[解说]
少阴：是十二经中的心肾二经，即手少阴心经，足少阴肾经。仲景治疗伤寒按六经分病，只称少阴，不分手足，似乎双方并重，但临床上足经病证较多，所以古人有伤寒传足不传手之说。
少阴之为病：是说什么是少阴病。
脉微细：脉，是寸口桡骨动脉。微，是微小，由于气虚。细，是纤细，由于血虚。
但欲寐：是神识开始昏迷，有想睡的状态。由于正气不足，被邪所困。
[评按]
这是认识少阴病最主要的两种症状。古人所以叫作少阴的提纲。
282．少阴病，想吐却吐不出来，心烦，只想睡觉，五六天后出现自利（自然下利）且口渴的，属于少阴病。因为虚，所以引水自救。如果小便颜色白的，少阴病的形证就具备了。小便白，是因为下焦虚寒，不能制约水液，所以令其色白。
[解说]
欲吐不吐：寒邪波及胃部的症状。
心烦：是心中麻烦，乃欲吐时的一种自觉症状。我家乡称欲吐症状为心烦，正是这个意思。与热证心烦不同之处是没有口苦舌干、口渴喜饮、小便赤等症。
白利而渴：利是大便粪稀；自利是没有任何引起下利的外界因素而自然形成的下利证。这种下利由于肾阳虚而有寒，大肠中的水分不能完全吸收故下利。下焦的水分既不能充分吸收，上焦的津液因而不能敷布，故口渴。仲景引水自救之说，正是说明这种口渴不是热证。
小便色白：也是阳虚有寒主症之一。仲景之解释清楚，不必重复。
[评按]
本节的重点有二：第一，补充提纲中阳虚症状之不足；第二，提出类似热证之口渴证让人加以区别。
283．病人脉阴阳俱紧，反而汗出的，是亡阳。这属于少阴，法当咽痛并且又吐又利。
[解说]
脉阴阳俱紧：紧，是脉象如转索状。阴阳指尺寸而言。这是“寒邪直中少阴”主症之一，是沉脉中的阴阳俱紧，与太阳篇第3节浮脉中的阴阳俱紧完全不同。
反汗出：言不应当出汗而出汗，是阴寒太甚。阳虚不能卫外所致。
亡阳：是阳气虚到极点的名词。
此属少阴：是说明亡阳证为少阴经阳气将绝独有的证候，其他部分之阳虚有寒，都不可以亡阳称之。
咽痛：虚阳上浮所致。
吐利：阳虚外脱之故。
284．少阴病，咳嗽并且下利，说胡话（谵语）的，是被火气劫夺的缘故。小便必定困难，因为强行要求少阴发汗。
[解说]
咳而下利：是肾阳虚水气不化，上冲于肺则咳，下走于肠则利。
谵语：寒水证本不能骤发谵语，今忽有谵语者，是由于被火气劫，发汗，心神亢越之故，不是热证。
小便难：也不是热证而是津伤，故仲景自注云“以强责少阴汗也”。
[评按]
本节之谵语一证。是火乱神明或是心神亢越，从字面上是不易认识清楚的，必须在临床上细心体会方能确定。
[解说]
脉细沉数：细为血虚，沉为在里，数与沉细并见为血虚有热之里证。
病为在里不可发汗：凡有表证者，或表寒直中阴经者，或表里证相兼者，这样或多或少均有发汗之法；凡是里证，不论虚寒虚热，均无发汗之道理，所以说病为在里不可发汗。
[评按]
仲景52节云“脉浮而数者，可发汗，宜麻黄汤”。可见数脉并不忌汗，但数而浮，病在表者，方可汗之。若数而沉细，病在里者，绝没有发汗之必要。因为本节是从表里上着眼。而不是从寒热上着眼。
286．少阴病，脉微，不可发汗，因为亡阳的缘故。阳气已虚，尺脉弱涩的，也不可用攻下法。
[评按]
真正的少阴病，在伤寒多是真阳虚，在温病便多是真阴虚，根本没有使用汗下的治法。麻黄附子二方是兼太阳之证。三承气汤证是阳极似阴的类似证，都不是纯粹的少阴证，决不可援以为例，以混淆少阴病的治法。
287．少阴病，脉紧，到了七八天自己下利，脉突然变微，手足反而温暖，脉紧反而消失的，是为将要痊愈。虽然心烦，下利，必定自愈。
[解说]
脉紧：是里寒证的脉象。
自下利：好像病势由寒转虚形成下焦虚脱之证。
脉暴微，紧反去：也好像是由寒转虚的脉象。
手足温，虽烦：只有这两种症状才是阳气回、阴寒退的主要现象。
[评按]
少阴虚寒之证能否治愈，主要以阳气之复与不复，阴寒之退与不退为标准。本节如果根据前三症来看根本没有自愈的希望，只有加上后二证才是阳回阴退的具体表现，才是病愈的真正标准。但“必自愈”三字，我认为不应该把它肯定起来，不用药等待自愈，仍应该根据症状作适当的处理，方不致误犯功败垂成之戒。
288．少阴病，下利，如果利自止，恶寒而蜷卧，手足温暖的，可治。
[解说]
下利：是少阴病阳虚证。
利自止：有两种机制，一是阳气来复，一是阴尽阳绝。前者乎足温暖，后者手足厥冷。本节之利自止是属于前者，所以手足温。
恶寒而蜷卧：蜷卧是四肢蜷曲而卧，是恶寒较甚的表现。
[评按]
本节可治之机也是阳气较胜之故。
289．少阴病，恶寒而蜷，时常自己心烦，想要去掉衣被的，可治。
[解说]
恶寒而蜷：是阳虚阴盛之证。
时自烦，欲去衣被：是阳气有来复之机。
[评按]
本病可治的关键也是阳气有来复之机的缘故。
[评按]
本节只言阳寸微，阴尺浮，并无其他症状，试问根据什么认为是少阴中风?病名尚不能肯定，又如何知道欲愈之脉?
编者按：上述评按是李老用红笔圈改后的字样。第一稿“病名”云云作“少阴中风有轻有重，难道任何中风这种脉象都是欲愈之脉?注家随文敷衍，有什么用处？”
291．少阴病欲解时，从子时至寅时。
[评按]
六经欲愈的时间，只可作为服药时的有利条件，就是在这个时间前3小时把药服下去，可能增加一些治愈的希望。但真正的效果究竟还在药之对证与否，时间是不能肯定的。
292．少阴病，吐利，手足不逆冷，反而发热的，不死。脉不至的，灸少阴七壮。
[解说]
少阴病吐利：是阴盛阳虚的寒证。
手足不逆冷，反发热者：是阳回阴退之热证，所以这两种症状并见绝不是死证。
脉不至：是吐泻交作之时，正气暴虚，脉象一时不能接续(急性霍乱证者经常发现)。
灸少阴七壮：即少阴经之太溪穴，在内踝后跟骨动脉陷中，七壮即艾炷七个以通阳复脉。
[评按]
本证内服温药外用灸法并行不悖，很有好处。陶氏用好酒姜汁半盏内服法也可试用。
293. 少阴病，八九日，一身手足尽热的，因为热在膀胱，必定便血。
[解说]
少阴病：此病应当脉微细数。
一身手足尽热：是少阴心经血虚有热。
热在膀胱：足心热由小肠而及于膀胱也。
便血：指小便血，这也是热伤阴络之证。
[评按]
过去书多多有寒邪变热之说，根据实践，除伤寒阳明病一方面由于患者素有内热，一方面由于伤了津液，这样是可能寒化为热的，至于少阴寒证主要由于阳虚所致，纵有发热之证，不是阴盛于内，格阳于外，或阴盛于下，格阳于上的假热，便是开始时期的太阳兼证，而真正阴寒变为阳热之证，从来没遇过。可能我的经验不多，也未可知，希望全国前辈多多指教为盼。
至于治疗之法，柯氏所用之黄连阿胶汤最宜，但苦燥之药应当少用，因为此证多属于阴虚之热，如果是真正实热，绝不可以少阴名之。
294．少阴病，只是厥冷无汗，而强行发汗的，必定动其血，不知从哪条道出来，或从口鼻，或从目出者，这叫做下厥上竭，为难治。
[解说]
但厥无汗：少阴病阳气衰微，不能温煦四肢，故手足厥冷，更不能蒸发津液而为汗，故无汗。这是少阴病的正常现象。
而强发之：少阴病除兼太阳发热证可以温阳微汗外，决不可强用发汗之法治之。
必动其血：如果强发其汗必然会形成各部出血证，因为汗为血之液，发汗药多辛温之品，所以不得其汗必动其血。
下厥上竭：下厥是指阳亡于下的厥证而言，上竭是指阴竭于上的出血而言。
难治：下厥当用热药，上竭当用凉药，相反相妨故为难治。
[评按]
各病的治法都必须根据古人多年来的经验，有成方者必须结合具体症状选用成方，有成法者也必须结合具体症状选用成法，既无成方又无成法者也可以触类引申以研究新的治法，这样即便不见效也绝无害处。如果无原则地随便用药，鲜有不损人者。本节强发汗之法，正是随便乱用药的典型事例，学者应当引以为戒。
[解说]
恶寒：阳气不足之证。
身蜷而利：阳虚寒甚之证。
手足逆冷：真阳已败之证。
不治：是因纯阴无阳之故。
[评按]
舒驰远说：此证尚未汗出息高，急投四逆加人参或可不死。我认为年龄体质及发现阴寒证的时间都有关系，在用药上宁重勿轻，并宜频频服之，使脉象逐渐恢复，以防止脉暴出的危险。
[解说]
吐利：是肠胃寒盛之证。
躁烦：躁系手足躁扰不安，为阳气欲离，属肾；烦系心中烦乱不耐嘈杂，为阳气无依。余详本证。
四逆：是手冷过肘，足冷过膝，乃阳亡之证。
[评按]
此系阳虚欲脱之候，故属死证，但在未死之前仍宜设法挽救，不可坐以待毙。要尽医者之责任，但必须预先告知病者亲属，以免误会。
[解说]
下利止：是阴竭于下，不是阳气有回复之机。
头眩：阴竭于下，阳无所附，浮越于上，故头眩。
时时自冒：冒是神识昏冒，由于阳浮于上，神气散乱之故。
[解说]
四逆：手冷过肘、足冷过膝的阴盛阳亡之证。
恶寒身蜷：是怕冷得厉害，身体蜷缩为一团。
脉不至：由于阴寒过盛，血脉不能畅行四肢，所谓真阳败绝之证。
不烦而躁：阳盛则烦，阴盛则躁，不烦而躁者，有阴无阳也。
[评按]
本节之死是有阴无阳之故。
[解说]
息高：是仅能呼气而不吸气之证，乃肾气下绝，肺气上脱之故。
300．少阴病。脉微细沉，只想睡觉，汗出不烦，自己想要吐，到了五六天自己下利，又烦躁不得卧寐的，死。
[解说]
脉微细沉：是少阴病之本脉。
但欲卧：是少阴病之本证。但较寐证轻。
汗出不烦：汗出是阳气外亡，不烦是内无热象。
自欲吐：是阴寒上逆。
至五六日自利：日期迁延较多，病势有所发展，故由吐而利。
复烦躁：是加上心中烦乱、手足躁扰不安之证。
不得卧寐：是因烦躁而发展为不能卧、不能睡之证。
[评按]
Note: For dysentery initially accompanied by exterior heat, Chai Hu (Bupleuri Radix) and Ge Gen (Puerariae Lobatae Radix) are the best medicines. Often, once the exterior syndrome is resolved, the dysentery heals; such examples are countless. However, in the late stage of dysentery, for syndromes of yin deficiency with heat or dysentery without exterior signs, blind use of lifting methods is of no benefit. Furthermore, Yin Hua (Lonicerae Japonicae Flos), when used raw and in heavy doses, is very effective. I have used it for a long time based on Zhang Shoufu's theory, but I have not tried it in charred form, so I do not know its effect. Shao Yao (Paeoniae Radix Alba/Rubra) can be used boldly during periods of intense damp-heat, without worry, as this has no adverse effects.
Original Text (42): "When prolonged dysentery injures yang qi, presenting with a deficient, slippery pulse and prolapse/looseness, treatment should focus on tonifying qi to secure and prevent collapse. The formula used is Zhen Ren Yang Zang Tang (True Person's Nourishment of the Viscera Decoction)."
Note: In cases of prolonged looseness/prolapse, tonifying qi is generally more appropriate than tonifying yang, because true cold syndromes due to yang deficiency are less common here, while heat syndromes are more prevalent. It is not a true cold syndrome, so hot-natured medicines should not be used lightly.
Original Text (44): "When summer-heat and dampness invade internally, causing abdominal pain, vomiting, diarrhea, chest fullness, and a slow pulse, it indicates turbid dampness obstructing the Taiyin. Suo Pi Yin (Spleen-Constricting Drink) is appropriate."
Note: Wang's assertion that a slow pulse warrants warming treatment is not sufficiently accurate; one must comprehend the situation comprehensively to avoid error.
Original Text (45): "During summer months, excessive drinking of cold liquids leads to internal retention of cold-dampness. Symptoms include upper vomiting and lower diarrhea, indistinguishable water and grain, cold limbs, and a hidden pulse. Treatment requires warm agents to regulate the spleen and stomach, promote qi circulation, and dispel cold. Da Shun San (Great Smooth Powder) is the formula."
Note: Zhongjing's Li Zhong Tang (Regulate the Middle Decoction) can serve as a reference, but precision is crucial. In summer cold-damp syndromes, excessive warming and tonification often transform into dysentery.
Original Text (46): "When damp pathogen injures the spleen and cold pathogen injures the kidney, leading to floating outward of deficient yang, symptoms include abdominal pain, diarrhea, chest fullness, irritability, thirst, and a rapid, large pulse that feels empty upon deep pressure. Treatment should employ 'hot for cold' method, i.e., taking hot medicine cold. Leng Xiang Yin Zi (Cold Fragrant Drink) is the formula."
Note: The exuberance of floating-outward deficient yang must be differentiated according to Meng Ying's diagnostic methods to ensure accuracy. Commentary on the first twenty-nine sections of the Shaoyin Chapter of Shanghan Lun
The Shaoyin Chapter of Shanghan Lun spans from section 281 to 325, totaling 45 sections. Among Li Hanqing's remaining materials, there are clinical commentaries on the first 29 sections of the Shaoyin Chapter. To faithfully reflect Master Li's scholarly approach and academic thought, this incomplete material is transcribed exactly as found, without supplementation or continuation.
281. The guideline for Shaoyin disease is: a faint and fine pulse, and a desire to sleep (somnolence).
[Explanation]
Shaoyin: Refers to the Heart and Kidney meridians among the twelve meridians, specifically the Hand-Shaoyin Heart Meridian and Foot-Shaoyin Kidney Meridian. Zhongjing categorized cold damage diseases by the Six Meridians, referring only to Shaoyin without distinguishing hand or foot, implying equal importance. However, clinically, foot meridian syndromes are more frequent, hence the ancient saying "cold damage transmits to the foot but not the hand."
Shaoyin zhi wei bing (What constitutes Shaoyin disease): Defines what Shaoyin disease is.
Mai Wei Xi (Faint and fine pulse): Pulse refers to the radial artery at the cunkou position. Wei (faint) indicates smallness due to qi deficiency. Xi (fine) indicates thinness due to blood deficiency.
Dan Yu Mei (Only desires sleep): Indicates the onset of mental cloudiness, a state of wanting to sleep. This results from insufficient righteous qi being trapped by pathogenic factors.
[Commentary]
These are the two most primary symptoms for recognizing Shaoyin disease, serving as the guideline for Shaoyin.
282. In Shaoyin disease, if the patient wants to vomit but cannot, experiences heart vexation, desires to sleep, and after five or six days develops spontaneous diarrhea and thirst, it belongs to Shaoyin. Due to deficiency, the patient draws water to save themselves. If the urine is white, the manifestations of Shaoyin disease are complete. White urine occurs because deficiency-cold in the lower jiao fails to control water, resulting in white color.
[Explanation]
Yu Tu Bu Tu (Wants to vomit but cannot): A symptom where cold pathogen affects the stomach.
Xin Fan (Heart vexation): A subjective feeling of mental trouble associated with the urge to vomit. In my hometown, this urge is called heart vexation, which aligns with this meaning. Unlike heart vexation in heat syndromes, it lacks bitter taste, dry tongue, thirst preferring drinks, and red urine.
Zi Li Er Ke (Spontaneous diarrhea and thirst): Li means loose stools; Zi Li means diarrhea formed naturally without external inducing factors. This diarrhea arises from kidney yang deficiency and cold, preventing complete absorption of water in the large intestine. Since lower jiao water is not fully absorbed, upper jiao fluids cannot distribute properly, causing thirst. Zhongjing's explanation of "drawing water to save oneself" clarifies that this thirst is not due to heat.
Xiao Bian Se Bai (White urine): Another main symptom of yang deficiency with cold. Zhongjing's explanation is clear and needs no repetition.
[Commentary]
This section has two focuses: First, supplementing the deficiency of yang-deficient symptoms in the guideline; Second, highlighting thirst resembling heat syndromes to distinguish them.
283. If a patient's pulse is tight at both cun and chi positions, yet they sweat, this is loss of yang. This belongs to Shaoyin, and the law dictates throat pain accompanied by vomiting and diarrhea.
[Explanation]
Mai Yin Yang Ju Jin (Pulse tight at both yin and yang/cun and chi): Jin (tight) describes a pulse like a turning rope. Yin and Yang refer to cun and chi positions. This is a main symptom of "cold pathogen directly striking Shaoyin," representing tightness in a deep pulse, completely different from the tightness in a floating pulse in Section 3 of the Taiyang Chapter.
Fan Han Chu (Contrarily sweating): Speaking of sweating when it should not occur, indicating extreme yin-cold. It results from yang deficiency failing to protect the exterior.
Wang Yang (Loss of yang): A term for yang qi being extremely deficient.
Ci Shu Shaoyin (This belongs to Shaoyin): Explains that loss of yang is a unique syndrome of impending exhaustion of shaoyin yang; other forms of yang deficiency with cold cannot be termed loss of yang.
Yan Tong (Throat pain): Caused by deficient yang floating upward.
Tu Li (Vomiting and diarrhea): Due to yang deficiency and external collapse.
284. In Shaoyin disease, if coughing and diarrhea are accompanied by delirium, it is due to coercion by fire qi. Urination will certainly be difficult, because sweat was forcibly extracted from Shaoyin.
[Explanation]
Ke Er Xia Li (Cough and diarrhea): Kidney yang deficiency fails to transform water qi; ascending to the lungs causes cough, descending to the intestines causes diarrhea.
Zhan Yu (Delirium): Cold-water syndromes do not suddenly cause delirium. Sudden delirium here results from coercion by fire qi and forced sweating, causing hyperactivity of the heart spirit, not a heat syndrome.
Xiao Bian Nan (Difficult urination): Not a heat syndrome but fluid injury, hence Zhongjing notes "because sweat was forcibly extracted from Shaoyin."
[Commentary]
The delirium in this section is caused by fire disturbing the mind spirit or heart spirit hyperactivity. It is not easy to recognize clearly from text alone; careful clinical experience is required to determine it.
285. In Shaoyin disease, with a fine, deep, and rapid pulse, the disease is in the interior; sweating is contraindicated.
[Explanation]
Mai Xi Shen Shu (Fine, deep, rapid pulse): Fine indicates blood deficiency; deep indicates interior location; rapid combined with fine and deep indicates interior syndrome of blood deficiency with heat.
Bing Wei Zai Li Bu Ke Fa Han (Disease in interior, cannot induce sweat): For those with exterior signs, direct invasion of cold into yin meridians, or combined exterior-interior signs, sweating methods apply to some extent. For interior syndromes, whether deficiency-cold or deficiency-heat, there is no rationale for sweating; thus, disease in the interior precludes sweating.
[Commentary]
Section 52 states "If pulse is floating and rapid, sweating may be induced, suitable for Ma Huang Tang." This shows rapid pulse does not forbid sweating; however, only if rapid and floating, indicating exterior disease, can sweating be used. If rapid, deep, and fine, indicating interior disease, there is absolutely no need to sweat. This section focuses on exterior vs. interior, not cold vs. heat.
286. In Shaoyin disease, with a faint pulse, sweating is contraindicated due to loss of yang. If yang is already deficient and the chi pulse is weak and choppy, purgation is also contraindicated.
[Explanation]
Mai Wei (Faint pulse): Indicates yang qi deficiency.
Chi Mai Ruo Se (Chi pulse weak and choppy): Indicates scanty yin blood.
[Commentary]
True Shaoyin disease in cold damage is mostly true yang deficiency, while in warm diseases, it is mostly true yin deficiency. There is fundamentally no place for sweating or purging treatments. Ma Huang and Fu Zi formulas address concurrent Taiyang syndromes. San Cheng Qi Tang syndromes are similar syndromes of extreme yang resembling yin; neither are pure Shaoyin syndromes. They should not be cited as examples to confuse Shaoyin treatment methods.
287. In Shaoyin disease, with a tight pulse, after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, hands and feet become warm, and the tight pulse disappears; this indicates impending resolution. Although there is vexation and diarrhea, it will surely heal itself.
[Explanation]
Mai Jin (Tight pulse): Pulse image of interior cold syndrome.
Zi Xia Li (Spontaneous lower diarrhea): Seems like disease trend shifting from cold to deficiency, forming lower jiao collapse syndrome.
Mai Bao Wei, Jin Fan Qu (Pulse suddenly faint, tightness disappears): Also seems like pulse image shifting from cold to deficiency.
Shou Zu Wen, Sui Fan (Hands and feet warm, though vexed): Only these two symptoms are main phenomena of yang returning and yin-cold retreating.
[Commentary]
Whether shaoyin deficiency-cold syndrome can be cured depends mainly on whether yang returns and yin-cold retreats. Based on the first three symptoms, there is no hope for self-healing; adding the last two symptoms shows specific manifestation of yang return and yin retreat, which is the true standard for cure. However, I believe the phrase "surely heals itself" should not be taken absolutely. Waiting for self-healing without medication is risky; appropriate handling based on symptoms is necessary to avoid failure at the last moment.
288. In Shaoyin disease, with diarrhea, if diarrhea stops spontaneously, accompanied by aversion to cold and curling up, but hands and feet are warm, it is treatable.
[Explanation]
Xia Li (Lower diarrhea): Yang deficiency syndrome of Shaoyin disease.
Li Zi Zhi (Diarrhea stops spontaneously): Two mechanisms: either yang qi recovers, or yin exhausts and yang perishes. Former has warm feet, latter has cold feet. Diarrhea stopping in this section belongs to the former, hence warm hands and feet.
E Han Er Quan Wo (Aversion to cold and curling up): Quan Wo means lying with limbs curled, indicating severe aversion to cold.
[Commentary]
The treatability in this section is also due to relatively superior yang qi.
289. In Shaoyin disease, with aversion to cold and curling up, occasional spontaneous vexation, and desire to remove clothes and blankets, it is treatable.
[Explanation]
E Han Er Quan (Aversion to cold and curling up): Syndrome of yang deficiency and yin excess.
Shi Zi Fan, Yu Qu Yi Bei (Occasional spontaneous vexation, desire to remove coverings): Indicates opportunity for yang qi recovery.
[Commentary]
The key to treatability in this disease is also the opportunity for yang qi recovery.
290. In Shaoyin wind-stroke, with pulse yang faint and yin floating, it indicates impending recovery.
[Commentary]
This section mentions only yang cun faint and yin chi floating, with no other symptoms. On what basis is it considered Shaoyin wind-stroke? If the disease name cannot be confirmed, how can one know the pulse of impending recovery?
Editor's Note: The above commentary is marked in red ink by Master Li. The first draft stated: "Shaoyin wind-stroke varies in severity. Is any wind-stroke pulse indicative of recovery? Commentators merely follow the text, what is the use?"
291. The time for Shaoyin disease to resolve is from Zi hour to Yin hour.
[Commentary]
The resolution times of the six meridians can only serve as favorable conditions for taking medicine. Taking medicine 3 hours before this time might increase hope for cure. But the true effect depends on whether the medicine matches the syndrome; time itself cannot guarantee it.
292. In Shaoyin disease, with vomiting and diarrhea, if hands and feet are not cold, but rather feverish, death is avoided. If the pulse is absent, moxa should be applied to Shaoyin seven times.
[Explanation]
Shaoyin Bing Tu Li (Shaoyin disease vomiting and diarrhea): Cold syndrome of yin excess and yang deficiency.
Zu Bu Ni Leng, Fan Re Zhe (Feet not cold, contrary fever): Heat syndrome of yang returning and yin retreating; thus, coexistence of these symptoms is definitely not a death case.
Mai Bu Zhi (Pulse absent): During alternating vomiting and diarrhea, righteous qi suddenly collapses, and pulse temporarily cannot continue (often seen in acute cholera cases).
Jiu Shaoyin Qi Zhuang (Moxa Shaoyin seven moxa cones): Refers to Taixi point of Shaoyin meridian, located in the depression behind the medial malleolus near the heel bone artery. Seven moxa cones are used to unblock yang and restore pulse.
[Commentary]
Internal administration of warm medicine combined with external moxibustion works well together and is beneficial. Tao's method of taking half a cup of good wine and ginger juice can also be tried.
293. In Shaoyin disease, after eight or nine days, if whole body and hands/feet are thoroughly heated, because heat is in the Bladder, hematuria will occur.
[Explanation]
Shaoyin Bing (Shaoyin disease): This disease should present with faint, fine, and rapid pulse.
Yi Shen Shou Zu Jin Re (Whole body and hands/feet thoroughly heated): Blood deficiency with heat in Shaoyin Heart Meridian.
Re Zai Pang Guang (Heat in Bladder): Heat in sole of foot spreads from Small Intestine to Bladder.
Bian Xue (Blood in stool/urine): Refers to blood in urine; this is also a syndrome of heat injuring yin collaterals.
[Commentary]
Old books often speak of cold pathogen transforming into heat. Based on practice, except for Yangming disease in cold damage, where patients usually have internal heat and injured fluids allowing cold to transform into heat, shaoyin cold syndromes are mainly due to yang deficiency. Even with fever, it is either false heat from yin excess inside repelling yang outside, or yin excess below repelling yang above, or initial Taiyang concurrent syndromes. I have never encountered true yin-cold transforming into yang-heat. Perhaps my experience is limited. I hope senior colleagues nationwide will offer guidance.
Regarding treatment, Ke Shi's Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is most suitable, but bitter-drying medicines should be used sparingly, as this syndrome mostly belongs to yin-deficiency heat. If it were true excess heat, it could not be named Shaoyin.
294. In Shaoyin disease, if there is only cold extremities without sweat, and sweating is forcibly induced, blood will certainly be disturbed. Unknown from which channel it exits, possibly from mouth/nose or eyes, this is called lower cold and upper exhaustion, and is difficult to treat.
[Explanation]
Dan Jue Wu Han (Only cold, no sweat): Shaoyin disease with declining yang qi fails to warm limbs, causing cold hands/feet, and cannot evaporate fluids into sweat, hence no sweat. This is normal for Shaoyin disease.
Er Qiang Fa Zhi (But forcibly induces sweat): Except for concurrent Taiyang fever syndrome where mild sweating with warming yang is allowed, Shaoyin disease should never be treated with forced sweating.
Bi Dong Qi Xue (Will certainly disturb blood): Forcibly inducing sweat will inevitably cause bleeding in various parts, because sweat is fluid of blood, and diaphoretics are mostly acrid-warm; thus, failing to sweat will disturb blood.
Xia Jue Shang Jie (Lower cold, upper exhaustion): Lower cold refers to cold syndrome with yang perishing below; upper exhaustion refers to bleeding due to yin exhaustion above.
Nan Zhi (Difficult to treat): Lower cold requires hot medicine, upper exhaustion requires cool medicine; opposing and conflicting makes it difficult to treat.
[Commentary]
Treatment methods for all diseases must be based on years of ancient experience. If established formulas exist, select them combining specific symptoms; if established methods exist, select them combining specific symptoms. If neither exists, extend by analogy to study new methods; even if ineffective, it causes no harm. Without principles, random medication rarely fails to harm people. The forced sweating method in this section is a typical example of random medication; students should take warning.
295. In Shaoyin disease, with aversion to cold, curling up, diarrhea, and cold extremities, it is untreatable.
[Explanation]
E Han (Aversion to cold): Syndrome of insufficient yang qi.
Shen Quan Er Li (Body curled and diarrhea): Syndrome of yang deficiency and severe cold.
Shou Zu Ni Leng (Cold extremities): Syndrome of true yang already failed.
Bu Zhi (Untreatable): Due to pure yin without yang.
[Commentary]
Shu Chi Yuan said: This syndrome has not yet sweated or had high breathing; urgently administering Si Ni Jia Ren Shen Tang (Counterflow Decoction plus Ginseng) might prevent death. I believe age, constitution, and timing of discovering yin-cold syndrome matter. In medication, prefer heavy over light doses, and administer frequently to gradually restore pulse, preventing dangerous sudden pulse emergence.
296. In Shaoyin disease, with vomiting, diarrhea, restlessness/vexation, and four reversals (cold extremities), death ensues.
[Explanation]
Tu Li (Vomiting and diarrhea): Syndrome of cold excess in stomach and intestines.
Zao Fan (Restlessness/Vexation): Zao refers to restless movement of limbs, indicating yang qi about to depart, belonging to Kidney; Fan refers to mental vexation and intolerance of noise, indicating yang qi having no support. Details see this syndrome.
Si Ni (Four reversals): Hands cold past elbows, feet cold past knees, syndrome of yang perishing.
[Commentary]
This is a sign of yang deficiency about to collapse, thus a death syndrome. However, before death, efforts should still be made to rescue; do not wait passively. Fulfill medical responsibility, but inform relatives beforehand to avoid misunderstanding.
297. In Shaoyin disease, if diarrhea stops but dizziness occurs, and periodic spontaneous vertigo/fainting ensues, death follows.
[Explanation]
Xia Li Zhi (Diarrhea stops): Yin exhaustion below, not an opportunity for yang recovery.
Tou Xuan (Dizziness): Yin exhaustion below, yang has no attachment, floats upward, causing dizziness.
Shi Shi Zi Mao (Periodic spontaneous vertigo): Mao refers to mental cloudiness/fainting, due to yang floating upward and spirit energy scattering.
[Commentary]
Death in this section is due to yin exhaustion below and yang collapse above.
298. In Shaoyin disease, with four reversals, aversion to cold, curling up, absent pulse, no vexation but restlessness, death ensues.
[Explanation]
Si Ni (Four reversals): Yin excess and yang perishing syndrome, hands cold past elbows, feet cold past knees.
E Han Shen Quan (Aversion to cold and curling up): Severe fear of cold, body curled into a ball.
Mai Bu Zhi (Absent pulse): Due to excessive yin-cold, blood vessels cannot circulate freely to limbs, so-called true yang failure and exhaustion.
Bu Fan Er Zao (No vexation but restlessness): Yang excess causes vexation, yin excess causes restlessness; no vexation but restlessness means yin without yang.
[Commentary]
Death in this section is due to yin without yang.
299. In Shaoyin disease, after six or seven days, high breathing indicates death.
[Explanation]
Xi Gao (High breathing): Ability to exhale but not inhale, due to kidney qi perishing below and lung qi escaping above.
[Commentary]
Cause of death in this section is exhaustion of vital qi in the kidney.
300. In Shaoyin disease, with faint, fine, deep pulse, only desiring to lie down, sweating without vexation, spontaneous desire to vomit, progressing to spontaneous diarrhea after five or six days, followed by restlessness/vexation and inability to lie/sleep, death ensues.
[Explanation]
Mai Wei Xi Chen (Faint, fine, deep pulse): Fundamental pulse of Shaoyin disease.
Dan Yu Wo (Only desires to lie down): Fundamental syndrome of Shaoyin disease, but lighter than somnolence.
Han Chu Bu Fan (Sweating without vexation): Sweating indicates yang escaping externally; no vexation indicates no internal heat signs.
Zi Yu Tu (Spontaneous desire to vomit): Yin-cold reversing upward.
Zhi Wu Liu Ri Zi Li (To fifth/sixth day spontaneous diarrhea): Prolonged duration, disease trend developing, thus changing from vomiting to diarrhea.
Fu Zao Fan (Again restlessness/vexation): Added mental vexation and limb restlessness.
Bu De Wo Mei (Unable to lie/sleep): Developed from restlessness/vexation to inability to lie or sleep.
[Commentary]